Use of Imaging to Prevent Unnecessary Workup and Answer a Clinical Question

With a fair percentage of all medical care deemed unnecessary for diagnosis and treatment, it is paramount that clinicians consider the rationale for each order and whether it is truly warranted. We present the case of a 71-year-old male with a history of Roux-en-Y gastric bypass who presented with choledocholithiasis and was found to have an incidental finding of a persistently narrowed segment of the right bile duct. With the usage of multiple imaging modalities, particularly CT angiography and intravascular ultrasound via an endobiliary route during biliary drain management, it was confirmed that the narrowing of concern was caused by a benign vascular compression by the right hepatic artery as opposed to a malignancy. This case demonstrates how minimally invasive imaging can reduce further potentially unnecessary tests, and thus costs, for patients.